Surgeon effects on cataract refractive outcomes are minimal compared with patient comorbidity and gender: an analysis of 490 987 cases

AimTo investigate effect of patient age, gender, comorbidities and surgeon on refractive outcomes following cataract surgery.MethodsStudy population: patients on UK national ophthalmic cataract database on cataract operations undertaken between 1 April 2010 and 31 August 2018. Variables examined included gender, age, diabetic retinopathy, glaucoma, high myopia, inherited retinal disease, optic nerve disease, uveitis, pseudoexfoliation, vitreous opacities, retinal pathology, cataract type, previous surgery and posterior capsular rupture. A multivariate normal cross-classified model was fitted to the refractive outcome using Markov Chain Monte Carlo (MCMC) methods with diffuse priors to approximate maximum likelihood estimation. A MCMC chain was generated with a burn-in of 5000 iterations and a monitoring chain of 50 000 iterations.Results490 987 cataract operations were performed on 351 864 patients by 2567 surgeons. Myopic and astigmatic errors were associated with posterior capsule rupture (−0.38/+0.04×72), glaucoma (−0.10/+0.05×95), previous vitrectomy (−0.049/+0.03×66) and high myopia (−0.07/+0.03×57). Hyperopic and astigmatic errors were associated with diabetic retinopathy (+0.08/+0.03×104), pseudoexfoliation (+0.07/+0.01×158), male gender (+0.12/+0.05×91) and age (−0.01/+0.06×97 per increasing decade). Inherited retinal disease, optic nerve disease, previous trabeculectomy, uveitis, brunescent/white cataract had no significant impact on the error of the refractive outcome. The effect of patient gender and comorbidity was additive. Surgeons only accounted for 4% of the unexplained variance in refractive outcome.ConclusionPatient comorbidities and gender account for small but statistically significant differences in refractive outcome, which are additive. Surgeon effects are very small.

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Multilevel Multivariate Modelling of The Effect of Gender and Patient Co-morbidity on Spherocylindrical Refractive Outcome Following Cataract Surgery

10.21203/rs.3.rs-136536/v1 ◽

2021 ◽

Author(s):

Rahael Hughes ◽

Petros Aristodemou ◽

John Sparrow ◽

Stephen Kaye

Keyword(s):

Diabetic Retinopathy ◽

Cataract Surgery ◽

High Myopia ◽

Case Series ◽

Likelihood Estimation ◽

Female Gender ◽

Mcmc Methods ◽

Refractive Outcome ◽

Refractive Outcomes ◽

Co Morbidity

Abstract Purpose To investigate effects of co-morbidities on refractive outcomes following cataract surgery.Design Case series database studyMethods Study population: patients on UK national ophthalmic cataract database. Variables examined included gender, age, diabetic retinopathy, glaucoma, high myopia, inherited eye disease, optic nerve disease, uveitis, pseudoexfoliation, vitreous opacities, retinal pathology, cataract type, previous surgery and posterior capsular rupture. A multivariate normal cross-classified model was fitted to the refractive outcome using Markov Chain Monte Carlo (MCMC) methods with diffuse priors to approximate maximum likelihood estimation. A MCMC chain was generated with a burn-in of 5000 iterations and a monitoring chain of 50,000 iterations. Main Outcome Measure Difference between postoperative and expected refractive outcome Results 490,987 cataract operations were performed on 351,864 patients by 2567 surgeons. Myopic and astigmatic errors were associated with female gender, glaucoma, previous trabeculectomy or vitrectomy, high myopia and increasing age. Hyperopic and astigmatic errors were associated with diabetic retinopathy, pseudoexfoliation and male sex. A large proportion of the unexplained variance in EERO was attributed to unobserved eye-level factors such as biometry measurements and IOL prediction formulae.Conclusions There was minimal variation between surgeons. Co-morbidities and gender accounted for small but significant differences significant differences in expected outcomes.

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